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2012-2013 Lions Clubs/District-Certificates of Insurance

In order to expedite the certificate issuance process, you now have the ability to create certificates of insurance on your own. Lions Club members can fill out and print one of these certificates using the form below.

If you need help or have any questions on certificates of insurance, please contact Willis Insurance at 800-316-6705.

Type of Certificate:

Option 1:

This form is used to show proof of insurance. No additional insured is needed.

Option 2:

This form is used to show proof of insurance and to add additional insured's for use of their premises.

Option 3:

This form is used to show proof of insurance and to add additional insured's - State or Political Subdivision - for issuance of permits.

Event Name & Date(s):

Requester Phone Number:

NOTE: Your phone number will NOT appear on the certificate.

Your Club/District:

Name:

City:

State:

Certificate Holder: This is the individual/entity to whom you are providing the certificate.

Name:

Address:

City:

State:

Zipcode:

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